Organization
JUDSON UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL DIDOMINICIS LCSW (CLINICAL SUPERVISOR)
(847) 628-2464
Entity
Organization
Contact information
Practice address
1151 N STATE ST, ELGIN, IL 60123-1404
(847) 628-2464
(847) 628-2044
Mailing address
1151 N STATE ST, ELGIN, IL 60123-1404
(847) 628-2464
(847) 628-2044
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
09/19/2017
Last updated
09/19/2017
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